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Current Bladder Dysfunction Reports
Published in: Current Bladder Dysfunction Reports 4/2018

01-12-2018 | Neurogenic Bladder (C Powell, Section Editor)

Contemporary Treatment of Detrusor Sphincter Dyssynergia: a Systematic Review

Authors: Hanhan Li, Nickolas Nahm, Alex Borchert, Philip Wong, Humphrey Atiemo

Published in: Current Bladder Dysfunction Reports | Issue 4/2018

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Abstract

Purpose of Review

To systematically review the literature to determine outcomes of detrusor sphincter dyssynergia (DSD) treatments. DSD can present in patients with neurogenic bladder due to a variety of conditions, but no treatment guidelines currently exist. Ovid Medline, Embase, PubMed, and Web of Science were searched within the last 10 years for “detrusor sphincter dyssynergia.” Results were independently reviewed by two coauthors for inclusion using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA) guidelines. Exclusion criteria were pediatric populations, reviews, non-clinical focus, non-English language, and case reports.

Recent Findings

There were 515 articles screened to yield 21 full text articles. Fourteen were retrospective studies, five were prospective non-randomized studies, and two were prospective, randomized trials. A total of 830 patients (527 male, 104 female, and 199 not specified) had DSD from spinal cord injury (413), multiple sclerosis (104), multiple system atrophy (33), and not specified (280). Treatments included botulinum A injections into the external sphincter (seven studies, reported success rates = 64–100%) or bladder (three studies, 44–76%), urethral stents (four studies, 9–91%), sphincterotomy (two studies, 48–85%), transurethral incision of the bladder neck (one study, 82%), pharmacologic therapy (three studies, 44–76%), sacral neuromodulation (one study, 60%), and anal stretch (one study).

Summary

Evaluation of treatment outcomes for DSD is lacking. If conservative therapy fails, botulinum toxin type A injection appears to be a primary intervention strategy. More invasive treatments such as sacral neuromodulation and transurethral incision of the bladder neck also demonstrated high success rates, while urethral stenting was associated with high complication and failure rates.
Appendix
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Metadata
Title
Contemporary Treatment of Detrusor Sphincter Dyssynergia: a Systematic Review
Authors
Hanhan Li
Nickolas Nahm
Alex Borchert
Philip Wong
Humphrey Atiemo
Publication date
01-12-2018
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 4/2018
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-018-0482-3

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